Change in Bowel Habit-last

8/6/2019 Change in Bowel Habit-last

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No rule for frequency of normal bowel

movements

The general range is from 3 times a day

to 3 times a week.

A bowel movement should be soft and

easy to pass, though some people may

have harder or softer stools than others.

HEALTHY BOWEL MOVEMENTThere is usually a time of day when bowel movementsare more likely to occurThe urge to defecate is often strongest in the morningLaxativesFood


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y Frequency of occurrence

y Texture

y Sudden change in the colour

y Consistency of stool

y Shape of stool


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y Excessive and frequent evacuation ofwatery faeces, usually indicatinggastrointestinal distress or disorder.

y Loose watery stooly condition of having three or more

loose or liquid bowel movements perday


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y Constipation is an acute or chronic condition in whichbowel movements occur less often than usual orconsist of hard, dry stools that are painful or difficult

to pass.y Bowel habits vary, but an adult who has not had a

bowel movement in three days or a child who has nothad a bowel movement in four days is consideredconstipated.


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y Nervous system of GIT

y Lies along the GIT

y Plexuses:y Myenteric plexus (Auerbachs)

y Between inner circular and outer longitudinal muscle

y For GI muscle movement

y Submucosal plexus (Meissners)

y In the submucosa

y For GI secretion & local blood flow


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y Extrinsic control by:y ParasympatheticNS

y SympatheticNS

y Sensory fibers travel through:

Luminalepithelium and

gut wallEnteric plexuses

Prevertebralganglia of spinal

cord

Spinal cord &brain stem


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y Parasympathetic stimulation increaseactivity of GITy Cranial and sacral division

y To first half of large intestine

y Sacral parasympatheticsy Through pelvic nerve

y To distal half of large intestine

y Sympathetic stimulationy Inhibit activity of GITy Have opposite effects of parasympathetic

stimulation


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y Integrated entirely within the gut wally GI secretion

y Peristalsis

y Mixing contraction

y Local inhibitory effectsy Gut prevertebral sympathetic ganglia GIT

y Eg: gastrocolic reflex

y Gutspinal cord / brain stem GITy Defecation reflex


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Distention of intestinaltract

Stimulate afferententeric neuron

Contraction ofsmooth muscleabove the bolus

Move food forward through the GIT

Also known as myenteric reflex

Food enterslumen

Activate excitatorymotor neuron

(Ach)

Activate inhibitorymotor neuron

Relaxation ofsmooth musclebelow the bolus

Peristalsis

Food moveforward

through GIT


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y Keep intestinal contents thoroughly mixed

y Differ in different parts of the body

y In some areas, the peristaltic contraction causes most mixing

y In other times, local intermittent constrictive contractionsoccur every few centimeters in the gut wally Chopping and shearing contents

Sphincter blocks intestinal contents + Peristalsis = Mixing of contents


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y Initiated by intrinsic reflex

Rectum stores fecesRectal walldistention,

rectal pressure

Stretch receptorsdetect

Afferent signals(myenteric plexus)

Desire todefecate

Relieve

Ignore

Peristaltic wavethru descending &

sigmoid colon,rectum

Constipation


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Peristaltic wave thrudescending & sigmoid colon,

rectum

Feces move towardsanus

Peristaltic wave reachesanus

Inhibitory signals(myenteric plexus)

Internal anal sphincterrelax

External anal sphincterconsciously relax

Pass stool


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y constipation that does not have a physical (anatomical)or physiological cause

y Bowel is healthy but not working properly

y When colon absorbs too much water or

y Slow stool movement in colony Due to slow muscle contraction hard stool

y Common causesy Not enough fiber and liquid in diet

y

Medicationsy Ignoring urge to defecate


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y Due to colonic obstruction

y Caused by:y Small intestine:

y Hernia

y Foreign bodies (gallstone, swallowed objects, etc.)

y Volvulus

y Large intestine:

y Neoplasms

y Hernias

y Transverse colonic volvulus


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y Flow of abnormal stool with increased frequencyy Acute: 4 weeks

y Persistent: 2-4 weeks

y Types:y Secretory

y Osmotic

y Exudative

y Inflammatory

y Dysentery


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y

Secretion of water > absorptiony Due to certain bacterial infections

y Eg: cholera byVibrio cholerae

Cholera toxinActivatesadenylylcyclase

intracell

cAMP(crypt

enterocytes)

Cl- channelsprolongedopening

watersecretion

Uncontrolledwater secretion

Affects ENS

Independentstimulus ofsecretion

Diarrhea


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y When ingested poorly absorbable substratey Eg: sorbitol cannot be absorbed into the body

draws water from body into the bowel

y Malabsorption - deficiencies of enzyme to process

disaccharidesy Eg: Lactose intolerance deficiency of lactase

Lactose isconsumed

No lactaseLactose

remains inlumen

Lactoseosmoticallyactive (holds

water in lumen)Passes large

intestine

Fermentedby colonicbacteria

Diarrhea

Excessivegas

production


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y No detectable organic causes

y A functional disorder

y Subgroups :y With diarrhea (common in male)

y With constipation (common in female)

y Mixed bowel habit


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Investigation


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y an increased frequency or decreased /consistency ofbowel movements

y increase in stool weight due to excess water, which

normally makes up 60-85% of fecal mattery acute, lasts one-two weeks,

y chronic, which continues for longer than 23 weeks


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y Associated with any injuryto GI track

- Fever

- Nausea- Vomiting

- Abdominal pain

y N

o. of bowel movementscan vary up to 20 or moreper day


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y Diarrhea needs to be distinguished from four otherconditions

- Incontinence of stool

- Rectal Urgency- Incomplete evacuation

- Bowel movements immediately after eating a meal


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y Acute diarrhoea

- Measurement of blood pressure (supine & lying down)

- Examination of a small amount of stool

- Usage of Antibiotics


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y ChronicDiarrhoea

- X-rays of the intestines (upper GI/barium enema)

- Endoscopy ( EGD)- Fat Malabsorption Fat in 72 hour stool

- Sugar Malabsorption hydrogen breath test

- Celiac disease blood test/biopsy of SI


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y Medication

- Antibiotics

- Bismuth Compounds

- Anti motility agent- Codeine phosphate

- Zinc

- Bile acid sequestrants


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y Change in the bowel habit or defecatory behaviour

- Resolved with relieve of constipation

y Infrequent bowel movement

- < 3x a weeky Difficulty during defecation

y Sensation of incomplete bowel evacuation


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y Medical History

y Physical Examination

y Blood test

y Abdominal X- Rayy Barium Enema


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y Dietary fiber (bulk-forming laxatives)

y Emollient laxatives (stool softeners)

y Hyperosmolar laxatives

y Saline laxativesy Stimulant laxatives

y Enemas


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Change in Bowel Habit-last

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